Being shortlisted as a finalist in the innovation category at the BJN Awards 2021 was a huge honour for both our nursing team and our healthcare services team at LloydsPharmacy Clinical Homecare, working in partnership with Royal Surrey NHS Foundation Trust. A lot of time and effort has gone into designing our healthcare centre concept, which is centred around improving patient care. In 2017, when we launched our first community-based clinic, we set out to transform how and where healthcare is offered. Being recognised for being forward-thinking and working collaboratively with the NHS to achieve that vision, regardless of whether we won the award, meant a great deal to everyone involved.
LloydsPharmacy Clinical Homecare started working with Royal Surrey in 2019 to develop an innovative mobile infusion service covering Surrey and West Sussex, that delivered high-risk cancer treatments outside of a hospital setting. This was driven by the Trust's need to help reduce hospital visits and increase capacity, allowing them to free up time and space in their hospitals to focus on more urgent care needs without having to expand their operating hours.
As a healthcare provider, we understand that patients want more choice and less stress when it comes to receiving treatment, and, equally, the NHS is looking for ways that it can adapt to meet the country's growing and changing healthcare needs. Trusts need to find ways to ease the pressure on their clinics and medical outpatient units, without compromising quality or safety. That is where our healthcare centres and nursing teams can help.
Outpatient infusion and injection treatment regimens typically require patients to visit hospital very frequently over the course of many months or years. As well as significantly disrupting patients' lives, the visit profile of these patients creates an incredible demand on hospital resources.
We understand that the practicalities of treatment can also cause stress and anxiety in patients and negative experiences can be further exacerbated by challenges to access car parking and long waiting times to see clinicians. Therefore, our services are designed around three key principles: patient experience, easy access, and quality of life.
Working collaboratively with clinical and operational teams across Royal Surrey, detailed stakeholder analysis and process mapping exercises were undertaken over a 6-month period to analyse existing patient pathways and clinical protocols. These helped to design and develop the service and the healthcare centre mobile clinic, based in Horsham (1 day a week) and Woking (2 days a week). The mobile unit was officially opened in February 2020 by Dame Judi Dench.
The mobile clinic offers a full end-to-end model of care, from medication supply, compounding, dispensing and delivery through to nurse administration. The services are delivered in a bespoke mobile infusion setting in the community, providing increased choice to patients in terms of where they want to receive their treatment. Treatment is delivered by an oncology nurse, meaning there is no change in the quality of their care and fewer visits to the hospital.
The healthcare centre mobile unit model is seen as an ‘enhanced’ homecare model which is well-established, but there are restrictions on medications that can be administered to patients in their own homes. As such, the healthcare centre model—with enhanced technology, access to hospital IT systems, robust escalation processes and integrated pharmacy processes—enables the provision of more complex treatments previously not delivered in the home. With this understanding, as well as service pathways delivered in hospital, the healthcare centre amalgamates best practice from both, to provide a unique facility, that until now, could not be delivered in the community.
‘Ultimately, our collaboration is all about bringing treatment close to home, to improve access to care for patients and make a difficult time as convenient and comfortable for them as possible’
For the Trust, the healthcare centre enables them to release capacity, manage their resources more effectively and meet their strategic objectives. For the patient, the healthcare centre gives them more choice about where they receive their treatment, which can help to reduce stress and give them a greater sense of feeling in control. It can also have a positive impact on mood because it makes it easier for patients to continue with their normal lives. Just because you are ill, you do not stop being a parent, a partner, or having other responsibilities. Having a treatment option that enables you to feel as normal as possible, to some people, can be a real blessing. It is a well-studied phenomenon that emotional wellbeing impacts long-term recovery and survival rates of patients with a physical illness. That is why offering more choice, at a time when life might feel restricted, is so important.
Ultimately our collaboration is all about bringing treatment closer to home, to improve access to care for patients and make a difficult time as convenient and comfortable for them as possible.
We wanted our submission to the BJN Awards to demonstrate how an NHS Trust and the independent sector have successfully partnered by implementing an innovative nurse-led service to cancer patients, moving treatments away from the hospital and closer to home, which has also since been implemented in other specialties, evidencing the proof of the concept.
We also felt the healthcare centre deserved to be recognised for its role in helping people to continue with the treatment they have needed during the past 12 months. Amid the initial stages of COVID-19, we saw a rapid increase in referrals. We worked closely to quickly expand the number of treatment protocols provided from 5 to 12, with the mobile unit enabling us to maintain capacity, while keeping patients socially distanced. Use of the mobile unit, along with telephone and video consultations, has enabled us to provide care throughout the pandemic in a low-risk environment, helping to keep patients safe and well.
This service has also proved highly beneficial to patients who have previously had to travel a significant distance to the cancer centre. They have been able to continue with their normal lives with treatment having a minimal disruptive impact. We all recognise that treatment can often make people feel very fatigued, but having their treatment closer to home has resulted in patients tolerating the rigorous appointment schedule.
The benefit to patients is also further backed up by a survey of 102 cancer patients, with possible responses ranging from ‘very satisfied’ to ‘very dissatisfied’. In all but one response, all patients surveyed reported being ‘very satisfied’ with:
- The environment: 100%
- Location: 100%
- Treatment waiting time (between 1 and 10 minutes): 86%
- Convenience of parking: 100%
- Whether the patient would recommend the service to family and friends: 100%.
The mobile infusion clinic has allowed nursing resources to be redistributed while improving patient outcomes, experience and quality of life. Alongside this, the service has supported cancer patients throughout the pandemic and avoided unnecessary deferrals of treatment at an unprecedented time.
There is substantial evidence to demonstrate that this service can be replicated across other specialties and we hope that other NHS Trusts will consider these types of enterprises so that more cancer patients can benefit from receiving their treatment in this way, with fewer visits to hospital.
We feel proud to be working with the team at Royal Surrey and believe our partnership shows what can be achieved through collaborative working. We are delighted to have been involved as a finalist and to have had our work recognised within the sector, alongside other leading healthcare providers.
Innovation is key to the future of healthcare, and we hope our partnership will inspire more collaboration and more forward thinking within the sector.